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A chest tube can be used to change a tracheostomy tube just as a Seldinger wire is used to change a central line. A good match for size is important. The flange should be cut off of the chest tube and the inspired oxygen should be increased. Positive pressure ventilation can be performed through the chest tube by the addition of an endotracheal tube adaptor at the cut off end.
Chest tube tracks may simulate normal structures or pathology. This article will help the radiologist to understand their formation and to recognize them as iatrogenic shadows.
Chest tube removal after coronary artery bypass graft is frequently reported by patients as stressful and painful, highlighting the need for effective nonpharmacological interventions. Slow deep breathing relaxation exercises (SDBREs) may serve as a simple nursing strategy to reduce discomfort. In this study, we aimed to evaluate the effect of SDBRE on pain and anxiety during and after chest tube removal following coronary artery bypass grafting in Nablus hospitals. An experimental design was used with 80 patients recruited from 2 hospitals. Participants were randomly assigned to either an intervention group (n = 40) that practiced SDBRE or a control group (n = 40) that received standard care. Data were collected through a self-administered questionnaire, the Numeric Pain Scale, and the Visual Anxiety Scale. Data collection occurred from March to October 2024. The intervention group reported significantly lower pain scores during removal (M: 5.325 vs 7.125, P < .001) and after removal (P < .001). Anxiety scores were significantly lower both during and after removal (P < .001). Pain correlated with duration, with more complex operations and prolonged chest tube insertion linked to higher scores. SDBRE significantly reduced pain and anxiety during and after chest tube removal, supporting its integration into routine postoperative nursing care.
Blood gas analysis of chest tube drainage following thoracostomy for experimental and clinical penetrating chest injuries was evaluated to determine its usefulness in predicting the etiology of the injury. Twenty dogs were divided into four groups and sustained right chest injury as follows: Group I--closed chest lung laceration; Group II--open chest lung laceration; Group IIII-gunshot wounds; Group IV--thoracotomy and injection of autologous, mixed venous blood. All animals and 14 patients who sustained penetrating chest injury were made simultaneously from chest tube draininage, systemic artery, and central vein in all dogs and patients. Eight patients (Group A) had pneumothorax; six patients (Group B) did not. Mean control canine aortic PO2 and pulmonary arterial PO2 values in Group I did not differ significantly from those in the other three canine groups, nor from the two human groups. Group II dogs exhibited chest tube PO2 which was significantly (p less than 0.01) above aortic PO2. In Group IV, chest tube PO2 was increased significantly above pulmonary arterial blood. Patients without pneumothorax had values for PO2 in chest tube drainage and aorta which were not significantly different, whereas when pneumothorax was present, PO2 of chest tube drainage was significantly higher than that of aortic PO2. Thus blood gas determinations on chest tube drainage may reflect the nature of the injury; however, the presence of air in the pleural space can result in oxygenation of contained blood well above systemic arterial levels.
A 62-year-old woman developed shock immediately after the insertion of a right-sided chest tube. A chest roentgenogram showed the chest tube to be overlying the heart and possibly compressing the right ventricle. An animal model was developed to replicate this clinical situation. Using a domestic goat model pulmonary artery, peripheral arterial catheters were inserted along with a right sided chest tube placed to suction. A second chest tube guided by a flexible fiberoptic bronchoscope placed within its lumen was positioned between the right ventricle and the sternum of the animals. Thirteen paired measurements in three goats (average of 4.3 measurements per animal) of cardiac output, heart rate, and mean arterial blood pressure were made at baseline and after chest tube placement over the right ventricle. The data were analyzed using a paired t test statistic. Compared with baseline measurements, there was a significant decrease in cardiac output (p less than 0.001) and mean arterial pressure (p less than 0.001) as well as an increase in heart rate (p = 0.0056) after placement of the chest tube across the right ventricle. We conclude that a misplaced chest tube compressing the right ventricle can impede cardiac output and lead to a low cardiac output state. Physicians inserting chest tubes in patients should be aware of this potential complication as it is easily treated by withdrawal of the chest tube.
Nurses prepare patients for chest tube removal, yet little has been written to indicate the sensations to be expected during this routine procedure. The sensations reported by patients and factors that could influence those sensations were examined in this study. The sample consisted of 36 patients after thoracic surgery (24 men and 12 women), all of whom were scheduled to have either a mediastinal or a pleural tube removed. They reported their sensations and the intensity of those sensations (using a 100 mm visual analog scale) within 15 minutes after tube removal. The most frequently reported sensation during chest tube removal was burning, followed by pain and pulling with mean intensities of 64, 62, and 45, respectively. Subjects reported having few sensations after the tube was removed with only five reporting soreness in the chest. The sensations and intensities did not differ for those who did and did not receive analgesia or for those having a pleural tube versus a mediastinal tube removed. The sensations were similar for the old and young subjects with younger subjects reporting higher intensities. Women reported pain more frequently than men, but the intensities of the sensations reported by men and women were not significantly different. The sensations reported during chest tube removal differ from those described in the literature and can be used to prepare patients more appropriately for chest tube removal.
The purpose of this study was to determine if chest tubes that are not milked or stripped occlude more frequently than milked or stripped tubes, and if the amount of drainage varies according to the treatment of the tubes. Following coronary artery bypass graft procedures, 49 male subjects had their chest tubes milked every 2 hours, had them stripped every 2 hours, or served as controls (i.e., their tubes were neither milked nor stripped). An analysis of variance was applied to the results. There was no significant difference in total drainage volume, hourly zero drainage, heart rate, or occurrence of arrhythmias among the three groups of subjects. Four to 16 hours postoperatively, a significantly higher volume of drainage occurred in the subjects whose chest tubes had been stripped. Stripping is particularly discouraged during this interval. The chest tubes remained patent with or without milking or stripping. We conclude that neither milking nor stripping is necessary for the proper care of chest tubes. We recommend that tubes be positioned such that they promote continuous drainage.
Catheters and chest tubes may be placed under fluoroscopic control to reduce pleural effusions. This procedure has been adopted as a routine procedure at the UCLA School of Medicine in Los Angeles, California to improve patient care. This technique was modified for the placement of large chest tubes, which can be placed by a radiologist without multiple attempts or complications. Our experience with 2234 patients who underwent this procedure between 1977 and 1990 is described.
The primary complication of transthoracic needle aspiration is pneumothorax. The efficacy and safety of using a small chest tube to treat this complication were examined by reviewing the records of 876 patients who underwent transthoracic needle aspirations between January 1981 and February 1986. Among these patients, 212 (24%) sustained a pneumothorax, and 92 (11%) required placement of a small 9-French chest tube attached to a flutter-type (Heimlich) valve. Duration of chest-tube drainage ranged between 24 hr and 3 weeks (mean, 2.2 days). Complete resolution of the pneumothorax and subsequent removal of the chest tube after 24 hr of drainage occurred in 38 (41%) of the 92 patients. Twenty-nine (32%) required 48 hr of drainage, and nine (10%) required 3 days. The remaining 16 (17%) required longer periods of drainage ranging from 4 days to 3 weeks. The tubes of six of this last group of patients were attached to a suction apparatus, and three of these patients eventually had a 28-French chest tube placed surgically. No significant complications occurred. The use of a small chest tube for treatment of pneumothorax after transthoracic needle aspiration is easy, safe, and efficacious.
We treated three patients with spontaneous left pneumothorax who underwent a long period of chest tube drainage before surgery. Case 1 was a 61-year-old man. On day 13 after drainage started, much air leakage occurred and surgery was done the next day. Case 2 was a 57-year-old man. Drainage failed to allow the air leakage to seal. The patient did not consent to surgery for about a month, but on day 38 after drainage started, he underwent surgery. Case 3 was a 19-year-old man. First, chest tube drainage was successful and he was extubated on day 16. However, pneumothorax recurred the next day. Liver dysfunction delayed surgical treatment, and the patient underwent surgery on day 54 after the first drainage. Postoperatively, he developed wound infection of the chest tube route and aseptic pleurisy of unknown origin. Limits of duration of unsuccessful chest tube drainage for the first episode of spontaneous pneumothorax are controversial. These cases suggest that when two weeks of chest tube drainage is unsuccessful, surgery should be undertaken in view of postoperative complication and social indications.
The purpose of the study was to determine the effects of two methods of clot clearance on chest tube drainage in patients undergoing myocardial revascularization. Two hundred adult patients immediately after myocardial revascularization were randomly assigned to a specific chest tube manipulation group. The dependent variables were drainage, incidence of cardiac tamponade, incidence of surgical reentry, hemodynamic values, and number of manipulation episodes. Statistical analyses revealed no difference in any of the dependent variables when milking and stripping were used. Of the 200 patients, 78 did not require any manipulation of the chest tubes in the first 8 hours after surgery. One patient had signs of cardiac tamponade and six other patients required surgical reentry. Positioning of the connecting tube in a nondependent position assisted with the removal of drainage from the chest cavity. In conclusion, patients having myocardial revascularization did not need their chest tubes manipulated the first 8 hours after surgery. Visible drainage in the chest tube did not cause a lack of patency.
The two major acute thoracic complications of closed chest tube thoracostomy are pulmonary laceration and vascular compression. We have noted that closed chest tube thoracostomy can also perforate an esophageal anastomosis or myotomy site. Clinically, such a perforation produces a profuse discharge of gas and/or fluid through a chest tube positioned at the level of the anastomosis or myotomy site. Plain films demonstrate an accumulation of extrapleural gas and/or fluid adjacent to the distal portion of the chest tube. If untreated, these accumulations may form into an extrapleural abscess.
Occasionally patients require long-term chest tube drainage. We describe a method whereby a short chest tube may be drained into a colostomy bag to alleviate the necessity of keeping the patient attached to a bulky drainage system. The colostomy bag allows greater mobility, and the patient can be discharged with the bag.
The authors describe an unusual complication of chest tube placement: subclavian vein lesion. After a literature review concerning complications of chest tube placement, the authors conclude that associated risks may be best minimized with a strict adherence to standardized technique and management protocol.
Knowledge of the indications, placement, and management of chest tubes in the intensive care unit is essential for the care of the critically ill patient. Awareness of the complications and mechanical difficulties that can occur with chest tubes and their drainage systems is essential for the safe and effective use of these devices.
A 2 mm Teflon catheter was used as a chest tube in 28 patients with iatrogenic pneumothorax. Frequent aspirations through the catheter were performed in 16 of the patients. In the remaining 12 patients the catheter was connected to a one way flutter valve. The treatment was successful in 27 of the 28 patients--one patient required a large calibre chest tube. The mean drainage time was 48 hours. The small catheter technique is superior to the use of a large intercostal drain as it is much less traumatic and troublesome. The small calibre chest tube with a one way valve is recommended as a safe and easy technique.
Two patients with known chronic ascites developed new massive right-sided pleural effusions. Chest tube placement led to massive protein and electrolyte depletion and death of both patients. Patients who have cirrhosis and massive right-sided pleural effusions, in general, have congenital diaphragmatic defects that predispose them to life-threatening fluid depletion when chest tubes are inserted. Hepatic hydrothorax is a relative contraindication to chest tube insertion.
The pleural drain with persistent air leak in six selected patients after pulmonary surgery was clamped or removed without causing pulmonary collapse. In all the patients, air leak through the chest tube was present when speaking or coughing but not seen when breathing normally at rest or taking deep breaths. The fact that the chest tube could be removed in selected patients is explained by supposing the air leakage through an alveolopleural fistula is dependent on pressure difference between the alveoli and the pleural cavity, and this was confirmed in a rethoracotomy case for persistent air leak. Removal of the chest tube following the above-mentioned rationale would reduce the number of rethoracotomy cases for air leak and facilitate early removal of the chest tube in some patients.